Mental Health: Targeted School-Based Cognitive Behavioral Therapy Programs to Reduce Depression and Anxiety Symptoms
Findings and Recommendations
The Community Preventive Services Task Force (CPSTF) recommends targeted school-based cognitive behavioral therapy (CBT) programs to reduce depression and anxiety symptoms among school-aged children and adolescents who are assessed to be at increased risk for these conditions.
The CPSTF also recommends Universal School-Based Cognitive Behavioral Therapy Programs to Reduce Depression and Anxiety Symptoms, and group and individual CBT to reduce psychological harm from traumatic events among children and adolescents.
The full CPSTF Finding and Rationale Statement and supporting documents for Mental Health: Targeted School-Based Cognitive Behavioral Therapy Programs to Reduce Depression and Anxiety Symptoms are available in The Community Guide Collection on CDC Stacks.
Intervention
Targeted school-based cognitive behavioral therapy (CBT) programs to reduce depression and anxiety symptoms are delivered to students who are assessed to be at increased risk for these conditions. The programs help students develop strategies to solve problems, regulate emotions, and establish helpful patterns of thought and behavior.
Trained school staff (e.g., school mental health professionals, trained teachers, nurses) or external mental health professionals (e.g., non-school psychologists, social workers) use therapeutic approaches outlined in an intervention protocol to engage with students in individual or group settings. They deliver the interventions during two or more sessions that are designed to reduce depression or anxiety symptoms and promote well-being.
About The Systematic Review
The CPSTF uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision-makers with additional, effective options. The following published review was selected and evaluated by a team of specialists in systematic review methods, and in research, practice, and policy related to mental health:
Werner-Seidler A, Perry Y, Calear AI, Newby JM, Christensen H. School-based depression and anxiety prevention programs for young people: a systematic review and meta-analysis. Clinical Psychology Review 2017;51;30-47.
The systematic review included 81 studies (search period through 2015). The team examined CBT programs for targeted school-based programs (29 studies) and universal school-based programs (38 studies) separately. The CPSTF finding is based on results from the published review, additional information from the subset of studies, and expert input from team members and the CPSTF.
Study Characteristics
- Depression symptoms were most frequently measured with the Children’s Depression Inventory, followed by the Beck Depression Inventory, and the Kiddie-Schedule for Affective Disorders and Schizophrenia.
- Anxiety symptoms were most frequently measured with the Spence Children’s Anxiety Scale, followed by the Revised Children’s Manifest Anxiety Scale.
- The included studies from the United States targeted adolescents (10-17 years), and were delivered by external mental health professionals (8 studies) or trained school staff (3 studies). Study populations represented a range of racial and ethnic groups.
Summary of Results
The systematic review included 29 studies of targeted school-based CBT.
- Small decreases were reported for symptoms of depression (21 studies) and anxiety (14 studies).
- Interventions delivered by external mental health professionals showed larger effects than those delivered by trained school staff.
Summary of Economic Evidence
A systematic review of economic evidence has not been conducted.
Applicability
The CPSTF finding should be applicable to school aged children (aged 7-18 years) in the United States.
Evidence Gaps
- How can advances in technology be used to improve intervention reach and availability at a population level?
- How do program results differ when asymptomatic youth participate?
- What effect does parental involvement have on outcomes? Which strategies work best to incentivize and engage parents or caregivers?
- What are the infrastructure and personnel needs required to sustain programs?
The CPSTF further identified the following evidence gaps as areas for future research:
- Which strategies best balance the need for parental awareness with child confidentiality?
- What are the long-term effects of early interventions to reduce anxiety and depression symptoms?
- Are programs as effective if implemented in private schools?
- What are the follow-up approaches that best support the maintenance of program effects over time?
Implementation Considerations and Resources
- Confidentiality of student information should be a priority, and policies should be clearly communicated to parents and students, especially when there will be group sessions.
- Programs should provide students with information about the group process, general risks associated with participation (e.g., privacy, confidentiality concerns or limitations), and rules for participation.
- Parents should be notified when students participate in programs or receive mental health services (though this must be balanced with student confidentiality).
- Students should have access to additional mental health services in case issues arise (either on-site or by referral).
- Referral processes should be in place and consistently followed by staff who detect possible child maltreatment or risk of harm to self or others.
- Schools should decide whether trained school personnel or external mental health professionals will deliver program components.
- School staff may be familiar with the student population and school environment, and there may be greater opportunities for program sustainability. They may not, however, have mental health training that would prepare them to handle additional issues.
- External mental health professionals are professionally trained for mental health issues, but they may not be as familiar with individual students, and additional funding may be required.
- Schools should decide whether universal CBT programs, targeted CBT programs for at-risk individuals, or both, are best suited for their student population. Some schools may prefer a stepped approach to deliver universal CBT programs first followed by targeted CBT programs for at-risk, symptomatic individuals who do not respond to the universal program. Other schools may prefer to deliver one program only.
Crosswalks
Healthy People 2030 includes the following objectives related to this CPSTF recommendation.